Brachial plexus injuries

Question 1

What are hte motor symptoms that would present with damage to the brachial plexus?

Answer 1

Paralysis and paresis

Question 2

What are the sensory symptoms that would present with damage to the brachial plexus?

Answer 2

anesthesisa or tinlkling and/or pain

Question 3

Injuries to the terminal branches can be caused by what?

Answer 3

Rupture

Overextension

Trapped

Question 4

What are the 4 ways a muscle can becomes trapped?

Answer 4

Hpertrophy of muscles

inflammation process

Compression

Growth of masses

Question 5

XYZ entrapment syndrome

Answer 5

musculocutaneous n. entrapped in coracobrachialis

Anterior interosseous n. entrapped in pronator teres

Question 6

Carpel tunnel syndrome

Answer 6

Entrapment of median nerve due to inflammation of the transverse carpal ligament

Question 7

Crutch Palsy

Answer 7

Radial Nerve Compression due to bad adjusted crutches

Question 8

XYZ tunnel syndrome

Answer 8

When a nere becomes entrapped in a tunnel

Question 9

Cubital tunnel Syndrome

Answer 9

Ulnar Nerve

Cubital tunnel is in the elbow and on the side of the medial epicondyle. Nearby muscle is flexor carpii ulnaris

Question 10

Guyon’s Tunnel Syndrome

Answer 10

Ulnar Nerve

Level 1: Ulnar nerve just proximal to the Guyons tunnel

• sensory and motor lost distal to entrapment

Level 2: deep motor branch of ulnar nerve inside Guyon’s tunnel

• only motot loss distal to entrapment

Level 3: superficial sensory branch of ulnar nerve at distal end of Guyon’s tunnel

• only sensory loss distal to entrapment

Fun Fact: Fibers to the hypothenar muscles can be spared because they originate proximal to the pishamate hiatus

Question 11

Neurological test for C5 lesions

(Motor)

Answer 11

1. arm abduct at the shoulder joint against resistances to test deltoid and supraspinatus muscle (axillary n. and supraspinatus n. Both C5 and C6)
2. Ask patient to flex forearm at the elbow joint against resistance to test Biceps and brachialis m. Testing musculocutaneous n. (main fibers C5, C6)
3. To test the infraspinatus muscle and teres minor (supraspinatus n. and axillary n. C5 &C6) - with elbow flexed, lateral rotation moves the hand away from the midline

Question 12

Neurological test for C5 lesion

(Reflex)

Answer 12

Check Biceps by tapping muscle tendon in the bicepital aponeurosis

Question 13

Neurological Test for C5

(sensory)

Answer 13

Testing Axillary nerve

lateral aspect of arm on the deltoid muscle (purest C5 dermatome)

Question 14

Neurological test of C6 lesion

(motor)

Answer 14

Test extensor carpi radialis by asking patient to extend hand against resistance

Test brachioradialis with flexion of the forearm against resistance

Weakness in wrist extension due to isolated C6 comprise results in ulnar deviation during wrist extension

Question 15

Neurological test for C6 (reflex)

Answer 15

Tap Brachioradialis tendon in the middle of the forearm.

If no reflex there is damage to C6 but not C5 (this can be compared to Biceps reflex)

Question 16

Neurological test for C6 lesion

(Sensory)

Answer 16

Testing Lateral Antebrachial Cutaneous Nerve

Light touch of lateral aspect of forearm

Question 17

Neurological test for C7

(Motor)

Answer 17

Ask patietn to extend their fingers, elbow extendion, and wrist flexion.

Testing triceps brachii (radial n.), wrist flexors (meadian and ulnar n.) and finger extensors (radial n.) - these are predominantely innervated by C7

C7 Lesion - wrist flexion results in an ulnarward deviation

Question 18

Neurological test for C7

(Reflex)

Answer 18

Tap triceps tendon on the back of elbow -> forearm should extend

Testing radial nerve

Question 19

Neurological Test for C7 lesion

(Sensory)

Answer 19

C7 supplies sensory nnervation to the middle finger.

However, because the middle finger may also recieve supply from C6 and c8, snesory evaluation of C7 is not reliable

Question 20

Neurological test for C8

(Motor)

Answer 20

Ask patient to flex fingers

Flexor digitorium superficialis and flexor digitorium profundus

Testing median and ulnar nerve

Question 21

Neurologica test for C8

(sensory)

Answer 21

Medial aspect of forearm and 4 th and 5th digit (anterior and posteriorly)

Question 22

Neurological test for T1

(motor)

Answer 22

Ask patient to adduct the fingers with a sheet of paper inbetween the two digits

This test the palmar interossei muscles (deep ulnar n. - C8 and T1)

Ask patient to abduct the fingers against resistance

This test dorsal interossei muscles (deep ulnar n. - C8, T1 but mainly T1)

Question 23

Neurological test for T1

(sensory)

Answer 23

Medial aspect of forearm (anterior and posterior)

Testing for medial antebrachial cutaneous nerve

Question 24

Lateral cord lesion (MOTOR)

Answer 24

Musculocutanoeus n. - biceps brachii

Medial n. (lateral leaf) - Flexor carpii radialis, polaris longus, flexor pollicis longus, flexor digitorium profundus (I and II) and superficialis

Median n. - pronator teres and quadratus

Question 25

Lateral cord Lesion (Reflex)

Answer 25

Test Bicep brachii

Question 26

Lateral Cord lesion (sensory)

Answer 26

Lateral cutaneous nerve of forearm

Question 27

Medial cord lesion (MOTOR)

Answer 27

Median n. (medial leaf) - abductor pollicis brevis, oppennes pollicis

Ulnar nerve - flexor carpii ulnaris, flexor digitorium profundus (III and IV), Adductor pollicis

Ulnar nerve and median nerve - Dorsal interossei and flexor pollicis brevis

Question 28

Medial Cord lesion (SENSORY)

Answer 28

Medial brachial cutaneous nerve and medial antebrachial cutaneous nerve

Question 29

Posterior cord lesion (MOTOR)

Answer 29

Subscapularis n. - Teres Major

Thoracodorsal n. - Latissimus dorse

Axillary n. - deltoid

Radial n. - triceps, supinator, extensor carpi radialis and ulnaris, brachioradialis, extensor digitorium

Question 30

Posterior Cord Lesion (REFLEX)

Answer 30

Triceps brachii

Question 31

Posterior Cord lesion (SENSORY)

Answer 31

Radial nerve (hand forearm posteriorly)